针对易于发生中膜动脉钙化的患者，床边诊断外周动脉疾病测试的可靠性：一项系统综述。
Reliability of bedside tests for diagnosing peripheral arterial disease in patients prone to medial arterial calcification: A systematic review.
作者信息
Brouwers Jeroen J W M, Willems Siem A, Goncalves Lauren N, Hamming Jaap F, Schepers Abbey
机构信息
Department of Vascular Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Department of Surgery, Haga Teaching Hospital, the Hague, the Netherlands.
出版信息
EClinicalMedicine. 2022 Jul 1;50:101532. doi: 10.1016/j.eclinm.2022.101532. eCollection 2022 Aug.
BACKGROUND
Medial arterial calcification (MAC), frequently associated with diabetes mellitus (DM) and chronic kidney disease (CKD), is a systemic vascular disorder leading to stiffness and incompressible arteries. These changes impede the accuracy of bedside tests to diagnose peripheral arterial disease (PAD). This review aimed to evaluate the reliability of bedside tests for the detection of PAD in patients prone to MAC.
METHODS
A systematic search (Pubmed, Embase, Web of Science, Cochrane, and Emcare) was performed according to the PRISMA guidelines to identify relevant studies providing data on the performance of bedside tests for the detection of PAD in patients prone to MAC. Studies were included when bedside test were compared to a reference standard. Primary endpoints were the positive and negative likelihood ratios (PLR, NLR). Methodological quality and risk of bias were evaluated using the QUADAS-2 tool.
FINDINGS
In total, 23 studies were included in this review. The most commonly evaluated test was the ankle-brachial index (ABI), followed by toe-brachial index (TBI), toe pressure (TP) measurements, and continuous wave Doppler (CWD). The majority of patients were older, male, and had DM. We found that ABI <0·9 was helpful to diagnose PAD, but failed to rule out PAD (NLR >0·2). The same applied for TP (NLR >0·3) and TBI (5 out of 6 studies revealed an NLR >0·2). CWD (loss of triphasic pattern) is reliable to exclude PAD (NLR 0-0·09), but was only validated in two studies. Overall, methodological quality was poor which led to risk of bias in 20 studies.
INTERPRETATION
The diagnosis of PAD in patients prone to MAC remains challenging. The ABI performed reasonably in the diagnosis of PAD, while the CWD (loss of triphasic signal) can be used to rule out PAD. This systematic review showed that test performances were generally poor with serious concerns in methodological quality of the included studies. We therefore counsel against the use of a single bedside test.
FUNDING
None to declare.
背景
内侧动脉钙化（MAC）常与糖尿病（DM）和慢性肾脏病（CKD）相关，是一种导致动脉僵硬和不可压缩的全身性血管疾病。这些变化会妨碍床边检测诊断外周动脉疾病（PAD）的准确性。本综述旨在评估床边检测在易患MAC的患者中检测PAD的可靠性。
方法
根据PRISMA指南进行系统检索（PubMed、Embase、Web of Science、Cochrane和Emcare），以识别提供易患MAC的患者床边检测检测PAD性能数据的相关研究。当将床边检测与参考标准进行比较时纳入研究。主要终点是阳性和阴性似然比（PLR、NLR）。使用QUADAS-2工具评估方法学质量和偏倚风险。
结果
本综述共纳入23项研究。最常评估的检测是踝臂指数（ABI），其次是趾臂指数（TBI）、趾压（TP）测量和连续波多普勒（CWD）。大多数患者为老年男性，患有糖尿病。我们发现ABI<0.9有助于诊断PAD，但未能排除PAD（NLR>0.2）。TP（NLR>0.3）和TBI（6项研究中有5项显示NLR>0.2）情况相同。CWD（三相波型消失）可可靠地排除PAD（NLR为0-0.09），但仅在两项研究中得到验证。总体而言，方法学质量较差，导致20项研究存在偏倚风险。
解读
在易患MAC的患者中诊断PAD仍然具有挑战性。ABI在PAD诊断中表现尚可，而CWD（三相波信号消失）可用于排除PAD。这项系统综述表明，检测性能总体较差，纳入研究的方法学质量存在严重问题。因此，我们建议不要使用单一的床边检测。
资金来源
无申报。
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